Provider Demographics
NPI:1437706355
Name:MACKIE, LYDIA PAIGE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:PAIGE
Last Name:MACKIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:DELANSON
Mailing Address - State:NY
Mailing Address - Zip Code:12053-3111
Mailing Address - Country:US
Mailing Address - Phone:518-895-8007
Mailing Address - Fax:
Practice Address - Street 1:119 E SHORE RD
Practice Address - Street 2:
Practice Address - City:DELANSON
Practice Address - State:NY
Practice Address - Zip Code:12053-3111
Practice Address - Country:US
Practice Address - Phone:518-895-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist